Value of Comprehensive HCV Treatment among Vulnerable, High-Risk Populations

Gigi A. Moreno, Alice Wang, Yuri Sánchez González, Oliver Díaz Espinosa, Diana K. Vania, Brian R. Edlin, Ronald Brookmeyer

Research output: Contribution to journalArticle

Abstract

Objectives The objective of this study was to explore the trade-offs society and payers make when expanding treatment access to patients with chronic hepatitis C virus (HCV) infection in early stages of disease as well as to vulnerable, high-risk populations, such as people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM-HIV). Methods A discrete time Markov model simulated HCV progression and treatment over 20 years. Population cohorts were defined by behaviors that influence the risk of HCV exposure: PWID, MSM-HIV, an overlap cohort of individuals who are both PWID and MSM-HIV, and all other adults. Six different treatment scenarios were modeled, with varying degrees of access to treatment at different fibrosis stages and to different risk cohorts. Benefits were measured as quality-adjusted life-years and a $150,000/quality-adjusted life-year valuation was used to assess social benefits. Results Compared with limiting treatment to METAVIR fibrosis stages F3 or F4 and excluding PWID, expanding treatment to patients in all fibrosis stages and including PWID reduces cumulative new infections by 55% over a 20-year horizon and reduces the prevalence of HCV by 93%. We find that treating all HCV-infected individuals is cost saving and net social benefits are over $500 billion greater compared with limiting treatment. Including PWID in treatment access saves 12,900 to 41,200 lives. Conclusions Increased access to treatment brings substantial value to society and over the long-term reduces costs for payers, as the benefits accrued from long-term reduction in prevalent and incident cases, mortality, and medical costs outweigh the cost of treatment.

Original languageEnglish (US)
Pages (from-to)736-744
Number of pages9
JournalValue in Health
Volume20
Issue number6
DOIs
StatePublished - Jun 2017

Keywords

  • Markov model
  • hepatitis C
  • men who have sex with men
  • people who inject drugs

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Fingerprint Dive into the research topics of 'Value of Comprehensive HCV Treatment among Vulnerable, High-Risk Populations'. Together they form a unique fingerprint.

  • Cite this

    Moreno, G. A., Wang, A., Sánchez González, Y., Díaz Espinosa, O., Vania, D. K., Edlin, B. R., & Brookmeyer, R. (2017). Value of Comprehensive HCV Treatment among Vulnerable, High-Risk Populations. Value in Health, 20(6), 736-744. https://doi.org/10.1016/j.jval.2017.01.015